Hello, and thank you for this valuable service you provide the public.

Roughly 2 weeks ago, I had an encounter with an escort in the USA.  She is visiting from Russia, which I've learned has a higher rate of STIs than Western countries.  We engaged in light kissing (w/out tongue), unprotected oral sex (mutual), and fully protected vaginal sex to completion. I am 100% certain the condom was used throughout the event and did not break.

72 hours later, I noticed yellow/green spots on my underwear and thick discharge from my penis. I went immediately to a clinic, where the Dr. took a urine sample and informed me that the protocol was to provide a shot of Rocephin and 4 simultaneous azithromycin pills.  The discharge cleared up entirely within 8-12 hours I’d estimate. The gonorrhea amplification and chlamydia amplification tests were negative. (Also, I did not urinate within 1-2 hrs of providing the sample, which I'm told can affect results).  The Dr. determined this was likely GCU, and said it could be due to a number of things, but that the important part was that the symptoms go away.

1. I've read on this board that you need to wait 5-6 days after an exposure for an accurate urine test. This was about 3 days. Does that still apply even when symptoms are present? In other words, should I trust the result or is this more likely a false negative?

2. Assuming it was not a false negative, is there anything that can or should be done at this time with the original sample after roughly 10 days? Is it possible and/or recommended to test it for more specific GCUs? Or is clearing up the symptoms all that matters?

3. I've also read here that such infections, while possible, are rare from oral sex. As such, I feel rather unlucky. Does any of this alter your view of the risk of insertive oral sex, especially as it relates to more serious conditions like HIV? Should I be concerned in this scenario?

Thank you.

Welcome to our Forum.  Thanks for your confidence in our service.  I'll be glad to comment. It sounds like you developed urethritis as the result of your oral exposure.  Like the clinician you saw, I would have thought you had gonorrhea and would have treated in the same way you were.  Your clinical response supports the diagnosis and I am suprised that your Gonorrhea urine test was negative.  There are two possible explanations.  One possibility it that, as you mention, you may have had a false negative test.  While this is possible, it is unlikely- the false positive rate for current tests is a small fraction of 1%.  In my opinion, it is more likely that your urethritis was caused by the meningococcus, aa bacterium closely related to gonorrhea which is relatively common in the throat and can cause symptoms quite similar to those of Gonorrhea.  In response to your specific questions:---

Thank you for the reply.

To clarify, I meant to say NGU, not GCU. My apologies.

To follow up:

1.   1. You state that you are surprised that the gonorrhea results turned up negative. If I recall properly, the doctor was leaning towards chlamydia, as that is more prevalent in the heterosexual community. Do I have that backwards? In any event, the doctor never even visually examined the discharge (even though I offered and showed her the underwear stains). I feel like once I mentioned the symptom(s) all she cared about was getting a urine sample.

2. If this is indeed meningococcus, I have to admit I am more than a bit scared right now. Hopefully, this is because I am completely unfamiliar with the condition. My (very) quick research, however, associates this strain with meningitis and sepsis, conditions I understand to be potentially fatal. Please help me understand what I am missing. Are we talking about two different things? 

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Thank you Dr Hook.

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